Provider Demographics
NPI:1760569719
Name:PUCCETTI, DANIELLE DENISE (MSW, LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DENISE
Last Name:PUCCETTI
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9025 N BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:HIXTON
Mailing Address - State:WI
Mailing Address - Zip Code:54635-8612
Mailing Address - Country:US
Mailing Address - Phone:412-667-0053
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:608-372-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7703-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical